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General NPI Number Information
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NPI Number | 1174163620
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Entity Type | Individual
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Provider Name | SAMANTHA SMITH GIPSON AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 101 DEVEREAUX DR
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City | MADISON
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State | MS
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Zip | 39110-9353
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Country | US
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Telephone | 601-946-9650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 903674
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License Number State | MS
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